The misuse of prescription painkillers, heroin and synthetic opioids like fentanyl is, by now, painfully well known. The U.S. tops the world in drug deaths; in 2015, more people died from overdoses — with two thirds involving an opioid — than from car accidents or gun violence.

The epidemic is also having a devastating effect on companies — large and small — and their ability to stay competitive. Managers and owners across the country are at a loss in how to deal with addicted workers and potential workers, calling the issue one of the biggest problems they face. Applicants are increasingly unwilling or unable to pass drug tests; then there are those who pass only to show signs of addiction once employed. Even more confounding: how to respond to employees who have a legitimate prescription for opioids but whose performance slips. “That is really the battlefield for us right now,” said Markus Dietrich, global manager of employee assistance and worklife services at chemical giant DuPont, which employs 46,000 worldwide.

The issue is amplifying labor shortages in industries like trucking, which has had difficulty for the last six years finding qualified workers. It’s also pushing employers to broaden their job searches, recruiting people from greater distances when roles can’t be filled with local workers. At stake is not only safety and productivity within companies — but the need for humans altogether, with some manufacturers claiming opioids force them to automate work faster.

YOUNGSTOWN, Ohio — Just a few miles from where President Trump will address his blue-collar base here Tuesday night, exactly the kind of middle-class factory jobs he has vowed to bring back from overseas are going begging.

It’s not that local workers lack the skills for these positions, many of which do not even require a high school diploma but pay $15 to $25 an hour and offer full benefits. Rather, the problem is that too many applicants — nearly half, in some cases — fail a drug test.

The fallout is not limited to the workers or their immediate families. Each quarter, Columbiana Boiler, a local company, forgoes roughly $200,000 worth of orders for its galvanized containers and kettles because of the manpower shortage, it says, with foreign rivals picking up the slack.

“Our main competitor in Germany can get things done more quickly because they have a better labor pool,” said Michael J. Sherwin, chief executive of the 123-year-old manufacturer. “We are always looking for people and have standard ads at all times, but at least 25 percent fail the drug tests.”

The economic impact of drug use on the work force is being felt across the country, and perhaps nowhere more than in this region, which is struggling to overcome decades of deindustrialization.

[W]hen it’s suggested that our current set of arrangements won’t last forever people immediately imagine Mad Max, as if no other alternative exists. Things are going to change. They always have and they always will. The future will just be different. That’s absolutely not the same as saying the world is coming to an end. Clear eyed individuals who are paying attention can start to get a feel for who the new winners and losers are likely to be and place themselves in the best possible situation ahead of the curve. That’s a pragmatist’s view – not a doomer’s.

. . .

If small scale agriculture was made redundant by mechanization and industrial scale production, then industry itself was hammered by other equally powerful forces. Everything has a beginning, middle, and end.

. . .

The most recent iteration of the Zombie Apocalypse has already begun to unfold in some places. Suburbia was exactly the right thing for a particular period of time. But that era is winding down. The modest tract homes and strip malls built after World War II are not holding up well in an increasing number of marginal landscapes. I have been accused of cherry picking my photo ops, particularly by people who engage in their own cherry picking when discussing the enduring value of prosperous suburbs. But there’s too much decay in far too many places to ignore the larger trend. The best pockets of suburbia will carry on just fine. But the majority of fair-to-middling stuff on the periphery is going down hard.

. . .

The future drivers of change will be the same as the previous century – only in reverse. The great industrial cities of the early twentieth century as well as the massive suburban megaplexes that came after them were only possible because of an underlaying high tide of cheap abundant resources, easy financing, complex national infrastructure, and highly organized and cohesive organizational structures. Those are the elements of expansion.

But once the peak has been reached there’s a relentless contraction. The marginal return on investment goes negative as the cost of maintaining all the aging structures and wildly inefficient attenuated systems becomes overwhelming. The places that do best in a prolonged retreat from complexity are the ones with the greatest underlying local resource base and most cohesive social structures relative to their populations. The most complex places with the most critical dependencies will fail first as the tide recedes.

. . .

Over the long haul Main Street has a pretty good chance of coming back along with the family farm. But the shorter term in-between period of adjustment to contraction is going to be rough as existing institutions attempt to maintain themselves at all costs.

A slew of reports finds a fresh reason for the chronic inability of American companies to fill skilled jobs: not a lack of skills, and hence a training-and-education crisis, but a surfeit of drug abuse, per the NYT’s Nelson Schwartz. Simply put, prime-working age Americans without a college diploma are often too drugged-out to get the best jobs. Opioids remain at high levels, but the surge in drug use is now heroin and the powerful contaminant fentanyl.

The reports suggest a circularity to the crisis in America’s rust and manufacturing belts: the loss of jobs and wage stagnation has led to widespread disaffection, alienation and drug abuse; and drug abuse has led to joblessness, hopelessness and disaffection.

But the numbers are all over the map. Some employers and economists say up to half of job applicants do not clear drug tests; others say it is 25%. In the chart above, Indeed economist Jed Kolko, using data from the U.S. Current Population Survey, found that 5.6% to 5.7% of working-age adults didn’t work last year because of illness or disability, an unknown percentage of which were because of drug use.